18 F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve Infective Endocarditis over the modified Duke Criteria.

Autor: Primus CP; Barts Heart Centre, St Bartholomew's Hospital, London, UK. christopher.primus@nhs.net.; Queen Mary, University of London, London, UK. christopher.primus@nhs.net., Clay TA; University College London, London, UK., McCue MS; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Wong K; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Uppal R; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Queen Mary, University of London, London, UK., Ambekar S; Barts Heart Centre, St Bartholomew's Hospital, London, UK., Das S; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Queen Mary, University of London, London, UK., Bhattacharyya S; Queen Mary, University of London, London, UK.; University College London, London, UK., Davies LC; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Queen Mary, University of London, London, UK., Woldman S; Barts Heart Centre, St Bartholomew's Hospital, London, UK.; Queen Mary, University of London, London, UK.; University College London, London, UK., Menezes LJ; University College London, London, UK.; UCL Institute of Nuclear Medicine, London, UK.
Jazyk: angličtina
Zdroj: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology [J Nucl Cardiol] 2022 Oct; Vol. 29 (5), pp. 2119-2128. Date of Electronic Publication: 2021 Jun 24.
DOI: 10.1007/s12350-021-02689-5
Abstrakt: Background: International guidance recognizes the shortcomings of the modified Duke Criteria (mDC) in diagnosing infective endocarditis (IE) when transoesophageal echocardiography (TOE) is equivocal. 18 F-FDG PET/CT (PET) has proven benefit in prosthetic valve endocarditis (PVE), but is restricted to extracardiac manifestations in native disease (NVE). We investigated the incremental benefit of PET over the mDC in NVE.
Methods: Dual-center retrospective study (2010-2018) of patients undergoing myocardial suppression PET for NVE and PVE. Cases were classified by mDC pre- and post-PET, and evaluated against discharge diagnosis. Receiver Operating Characteristic (ROC) analysis and net reclassification index (NRI) assessed diagnostic performance. Valve standardized uptake value (SUV) was recorded.
Results: 69/88 PET studies were evaluated across 668 patients. At discharge, 20/32 had confirmed NVE, 22/37 PVE, and 19/69 patients required surgery. PET accurately re-classified patients from possible, to definite or rejected (NRI: NVE 0.89; PVE 0.90), with significant incremental benefit in both NVE (AUC 0.883 vs 0.750) and PVE (0.877 vs 0.633). Sensitivity and specificity were 75% and 92% in NVE; 87% and 86% in PVE. Duration of antibiotics and C-reactive Protein level did not impact performance. No diagnostic SUV cut-off was identified.
Conclusion: PET improves diagnostic certainty when combined with mDC in NVE and PVE.
(© 2021. The Author(s).)
Databáze: MEDLINE
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